Implementing clinician-led sustainability interventions in a tertiary intensive care unit: a quality improvement evaluation

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2026
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Abstract
BACKGROUND: Intensive care units are resource-intensive clinical environments with substantial material and environmental impacts. This study evaluated whether clinician-led sustainability interventions implemented through established quality improvement methods could reduce resource use while maintaining explicit safety oversight. METHODS: We conducted a single-centre pre-post quality improvement evaluation in a 34-bed tertiary intensive care unit in Singapore. Following baseline audits, multidisciplinary stakeholder engagement and pragmatic prioritisation, three interventions were implemented: digitisation of clinical competency documentation, stewardship of ventilator circuits during intrahospital transport and replacement of conventional sharps containers with repurposed disinfectant canisters for arterial blood gas syringe disposal. Interventions were refined using Plan-Do-Study-Act cycles; a structured process-redesign framework guided digitisation, and Failure Modes and Effects Analysis informed risk mitigation for ventilator-circuit stewardship. Primary outcomes were changes in material use. Secondary outcomes included estimated environmental and cost impacts, staff acceptability and safety events identified through routine surveillance and incident reporting. RESULTS: Full digitisation eliminated approximately 27,000 paper sheets annually. Ventilator-circuit use decreased by approximately three circuits per intubated admission, equivalent to an annualised reduction of 558 circuits. Repurposed canisters completely replaced 403 conventional sharps containers annually. These changes corresponded to an estimated annual reduction of approximately 866 kg carbon dioxide equivalent. All 21 eligible respiratory therapists completed the circuit-stewardship survey, with favourable ratings for usability, preference and perceived safety. Repurposed canisters were preferred over conventional sharps containers without a significant difference in perceived safety. No adverse events attributable to the revised workflows were detected. CONCLUSION: Clinician-led sustainability interventions integrated into established intensive care unit quality and safety processes were associated with measurable reductions in material use. Multidisciplinary prioritisation, iterative testing and intervention-specific risk assessment provide a transferable approach for implementing sustainability initiatives in critical care.
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Authors Wei Jun Dan Ong, Faheem Ahmed Khan, Woon Hean Keenan Chong, Lawrence Ace Azul, Amit Kansal
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Journal International journal for quality in health care : journal of the International Society for Quality in Health Care
Year 2026
DOI
10.1093/intqhc/mzag132
URL
https://doi.org/10.1093/intqhc/mzag132
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